Introduction

Learning objectives

Recognize that many renal masses are detected incidentally.
Know the studies used to characterize a renal mass.
Understand that size alone does not determine the treatment strategy.

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Video lesson

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Video pending upload (embedded YouTube)

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Summary

Many renal masses are now detected incidentally during an ultrasound or CT ordered for another reason.

What to do?

A solid renal lesion or a complex cystic lesion requires adequate characterization.

The studies commonly used are:

CT with renal protocol and contrast;
MRI when indicated.

When to refer?

A suspicious solid renal mass or complex renal cyst should be evaluated by Urology.

Size alone does not mean a nephrectomy must be performed.

Depending on the characteristics of the tumor and the patient, the following may be considered:

active surveillance;
ablation in selected patients;
partial nephrectomy;
radical nephrectomy.

⚠️ Urgent referral

If the mass is accompanied by:

significant hematuria;
bleeding;
clinical deterioration;
significant acute pain associated with a complication.

Key concept

Renal mass ≠ automatic nephrectomy. It must first be characterized, and only then is the treatment strategy decided.

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PDF

⬇ Download lesson summary

Downloadable PDF pending upload.

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Practical algorithm

🔴 Urgent referral / emergency

Sudden testicular pain → rule out torsion.
Fever/sepsis + obstructed urinary tract → urgent urinary drainage.
Acute urinary retention → bladder decompression; urgent referral if it cannot be resolved or if complications are present.
Hematuria + clot retention → urgent assessment and management.
Trauma + suspected urethral injury → avoid repeated blind catheterization attempts.

🟠 Priority referral

Solid testicular mass → rule out tumor.
Suspicious renal mass → characterization and urologic evaluation.
Gross hematuria → investigate the cause.
Persistently elevated PSA/suspicious DRE → prostate cancer risk assessment.

🟢 Scheduled referral depending on context

Recurrent UTI → look for a predisposing cause.
Erectile dysfunction → refer if complex, refractory, or with associated pathology.
Urinary incontinence → refer if complex, if warning signs are present, or if initial management fails.

The primary care physician does not need to resolve all urologic pathology. They must know how to perform an initial evaluation, recognize warning signs and, above all, distinguish which patient can wait from the one in whom a delay may compromise an organ, renal function, or even life.

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Clinical case

Content pending upload Progressive clinical case focused on decision-making.

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Self-assessment

Questions pending upload 5–10 multiple-choice questions on this lesson.

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References

Links pending upload References to PubMed, DOI, scientific society guidelines and journals.

Renal mass